Baumbach SF, et al. - In this retrospective registry study, researchers compared unfixed, CRIF, and open reduction and internal fixation (ORIF) of the posterior malleolus fragment (PMF) regarding the frequency of trans-syndesmotic fixation and quality of reduction in trimalleolar (equivalent) fractures. Two hundred and thirty-six patients with a trimalleolar (equivalent) ankle fractures were identified within the departments’ fracture database. They observed a significantly decreased necessity for additional trans-syndesmotic fixation when ORIF of the PM fragment was done. This procedure led to a significantly superior quality of reduction compared to CRIF by AP screws or untreated PM fractures. For all PM fragments, these findings remained consistent irrespective of their size.